Army Standardizes Ptsd Diagnosis, Treatment

[Tim Cake]

If only it were as easy as it sounds. Given that cynicism and distrust are on most (if not all) lists of PTSD symptoms, it makes treatment quite a challenge. I've been seeing a new therapist on a weekly basis myself since early April this year and there are critical aspects of my behavior that I have yet to share with him. Seriously, I thought that perhaps one of the benefits of paying out of my own pocket for an outside therapist would make me more trustful and, therefore, more open. In some ways it has, but there's still hesitation on my part to discuss some behaviors that, quite frankly, I'm ashamed of. Isn't it funny how the very things we want to be cured of can be so shameful to us that we're not comfortable enough to even reveal them?

I admit to being a cynical old SOB...

 

[JarHed]

I admit to being a cynical old SOB...

Hey I thought that was my job.


Therapy is always difficult. Like when you say something and they ask, 'So, how do you feel about that?'

You always have the answer, maybe you either can't verbalize it or won't but you know that you know. And I'm with the other Jarhead, no pain, no gain. It's still easier than getting shot at.

 

[Sarg]

First question is, where are you going to get a COMPETANT licensed professional P-doc at the VA? Unfortunately, most of the Drs. I saw at my VA, got their med ed. in the back room of a bicycle shop in Jakarta. Sorry, but my disdain for the VA bleeds through my ability to keep my mouth shut.

Like you, Var, I choose to see a private P-Doc and therapist and pay for it out of my own pocket. I know some of you guys can't do that and it is my highest hope that your VA is different. I just saw way too many outright blunders at the one I went to.

Having an engineering background, I once did a value engineering study of the VA versus private. When one examines VA operations, one finds the whole system bloated with middle management. Taking that into consideration, it actually would benefit the taxpayer as well as the Veteran to close the VAs and issue plastic cards to Vet to see the Drs. of their choice.

Massive costs in maintain very old buildings and bloated management (including bonuses, gold plated retirement systems) push the patient/treatment/hour index through the roof.

Said "study" found it's way back to the management at my VA and started my "divestature" of the VA system. Actually, I'm glad they told me to "go out and get my own Drs", they didn't need to say it twice.

Sarg

 

[anthony]

That is another misrepresentation about healing trauma and PTSD, in that you have to talk about your trauma. That is not factual at all. You will certainly want to talk about specific parts that bother you the most, however; your focus to heal isn't in the past, it is what you feel in the present. The past is purely the past... it contains things that are annoying your present. You can't change your past, you can only change your present and future, hence where you focus to heal PTSD. Present tense then writes a different past, which writes a better and better future as you go.

Therapy in a controlled environment is also old nonsense... in fact many studies have already found the best results for PTSD are done via the computer, email, one on one communication programs, etc. It is because people with trauma are more willing to talk about it in writing, than express it in face to face situations. Yes, the face to face needs to happen at some point to shift past that issue, as you can't teach a person to run from that, especially when communication is a hot topic in healing PTSD. But the worst of it can all be done via text. It is the feedback that is important, and the angles coming back to make you think of different situations.

You also need one on one time with a person in practical situations IMHO... outside a therapy room, in the real world. You would quite surprised what can be accomplished when in a practical situation and talking with the person about what goes through their head then and there, versus them trying to recall and recount what they felt / thought. Putting yourself into the world to experience and get exposure, whilst also doing cognitive work to correct the issues, helps a lot IMHO.

 

[Wagon]

Hmmm. The past.

I've had PTSD for more than 20 years. The bitch about that is I have only known and addressed it for the past year and a half. Allot of catch up.

For many years I tried to erase 4 years of my life. Did a pretty good job. Threw away most of my stuff. Uniforms, medals, most pictures are gone as well. There is a box somewhere. Been carting it around the world. Never gets unpacked.

So today as a part of cognitive, I'm doing a review of that 4 years. The things that have helped me the most in this game is information and sorting out the past in order to address my triggers. Know where they are from and as someone here said "assign it to the dust bin of history". I have some selective amnesia going on. 1 year of the military is very spotty. It is when allot of shit happened. I'm slowly marching towards that year.

So for myself the past is a bit of a key to heal now. I of course understand the need to heal in the present as myself at this point in time. But somehow, knowing the hows and whys helps me do that. I've been shoving allot of crap deep down inside for many years. Unfortunately with that method I ended up losing everything every 5 to 8 years. 3 complete mental breakdowns in 20 years. That shit has to stop.

And on that note.......I'm off to the shrink.

 

[RC135Linguist]

That is another misrepresentation about healing trauma and PTSD, in that you have to talk about your trauma. That is not factual at all. You will certainly want to talk about specific parts that bother you the most, however; your focus to heal isn't in the past, it is what you feel in the present. The past is purely the past... it contains things that are annoying your present. You can't change your past, you can only change your present and future, hence where you focus to heal PTSD. Present tense then writes a different past, which writes a better and better future as you go..

I know you're more educated in this field than I am and I certainly won't claim to speak for anyone else but myself. But, you seem to indicate that it's okay to talk about the past briefly during therapy and that it shouldn't play an integral part in the actual treatment and healing process. I, for one, feel that I have personal issues and reasons to disagree with you (at least in part.)

I've mentioned in at least one other post the propensity of us PTSDers to be cynical and distrustful. It goes with the territory. Due to my general lack of trust there are behaviors and things that I do in the present that take me a very long time to talk about, no matter who it is I might want to share them with. The method I use to build up enough trust and to be able to share such intimate details with someone is to talk - and talk - and talk with that person. How did he react to such and such an event? What were his thoughts on this or that detail of my life during my past and up to the present? As someone whose PTSD remained untreated for more than 35 years, I'm not very trusting at all and I have lots of things to talk about that have gotten me into my current state.

Another reason I think it's appropriate to talk at length about our past is that it is (or should be) extremely important for a therapist to know as much as possible in order to arrive at a complete diagnosis and then to begin treatment. For example, which disorders might be directly related to my PTSD and which may not be? If it turns out that I'm bi-polar, is it part of my PTSD? What affect might that have on my treatment? Was one of my disorders present before I was exposed to the traumatic event, or is it totally a consequence of it? It isn't like we as patients can waltz into a doctor's office with our own predefined list of conditions or disorders. It's up to the physician to diagnosis us completely, and for that I believe they need to know more than just what is happening with us in the present. I have a couple of friends and acquaintances who were misdiagnosed completely because they came to their own conclusions about what they were suffering from and reported it to their doctors or therapists - only to receive the wrong treatments, some having been given medications that they never should have taken.

I might contrast this with a patient going to the emergency room with a 6 inch cut on his arm. The medical staff might ask how the cut got there, but it really doesn't matter that much when it comes to dictating the kind of treatment he gets. The cut will be disinfected, stitched, and then bandaged, whether it was caused by a knife or a shard of glass or a razor blade. If, on the other hand, a patient suffering from PTSD is diagnosed with depression and anxiety, might his treatment be different if the depression and anxiety were caused 100% by the traumatic event versus being originally caused by some events earlier in his life? If the treatment involves just doping the patient up with medications then it may not make a difference what the cause was, but if the treatment involves intense therapy alone then I would think it could very well make a difference as to how the disorder originated.

Well, again I've written too long of a long post. I apologize for that and I welcome any enlightenment that comes my way.

Thanks for the opportunity to post!

VAR

 

[anthony]

What were his thoughts on this or that detail of my life during my past and up to the present?

You're talking about your way of testing a person though, for your own personal gain towards building trust and reading the other person as to whether you will trust them, or not.

Another reason I think it's appropriate to talk at length about our past is that it is (or should be) extremely important for a therapist to know as much as possible in order to arrive at a complete diagnosis and then to begin treatment. For example, which disorders might be directly related to my PTSD and which may not be? If it turns out that I'm bi-polar, is it part of my PTSD? What affect might that have on my treatment? Was one of my disorders present before I was exposed to the traumatic event, or is it totally a consequence of it?

Now you're referring to past in relation to diagnostic medicine. Yes, past information dictates though, however; that has nothing to do with what necessarily "affects" you negatively.

I can talk about most of my past, no affect to me... I've beaten the troubled spots to death and the rest is just my history. It is about the negative connotations from your past. No amount of talking about them is going to change them, because what you felt then and what you feel now are very different things.

Your past is your past... what you share of it is your choice. My point is that there is no requirement to sit in your past and dwell upon it, again, you cannot change it. All negativity that comes from specific past events is in your present (changeable), based on your past (unchangeable). If you want to talk about it, sure, and if it helps, great, but there is no requirement to focus on your past to heal your present or change your future.

 

[Tim Cake]

Amen to that Anthony.

 

[vikingr12]

I broke down and went to the VA recently because of various issues but the Beast was the major one. A friend had been there in Pennsylvania and convinced me to finally go after years of avoiding it. Strangely, I got through the main desk. The last time they had no idea who I was. No records. Nothing.

As the article says, my thinking is that the Army (Armed Forces) has no idea how to treat PTSD. When it becomes a matter of statistics, as it always does in the VA, the cure is lost and nothing happens.

The doc was very understanding but said they have no specialists at this VA hospital. She referred me to some civilian therapists and suggested (which is what you do with me) some meds, the Rx none of which I filled. Been there done that. I went to the psych one time and quit. So I guess I fit the pattern of mentally homeless guys walking around carrying a bowling ball. Sleep and eat. Oh, watch TV but avoid the war movies.

Then I had the AC fixed and the guy told me of his young relative in Iraq, who was emptying the helos after a mission and set down a box of grenades. One went off and vaporized the guy next to him. He had lacerations of the head and face. He's at Walter Reed still.

The cycle continues. It's really not the war or the issues of it. I would do it again.

It's the afterwards.

 

[Tim Cake]

Naww. It's very simple. The VA just got a billion dollars in extra funds. So we launch a standardization drive and have teams of people travel around and collect data and study. Then we'll have regional meetings and argue for days over bad coffee and sandwich trays about best practice.

After this we will have the National VA Conference in Las Vegas....no no wait. Harry was just there. Ok, We'll do it in Atlantic city. Cheaper. HA! Ok National Meeting. All best practices will be presented and talked about at length for at least 5 days. Nothing will be decided.

Combine all best practices into one big list and role them out as the standard nation wide. All centers suddenly realize they are completely undermanned and unprepared to operate all the best practices. Hiring standards are lowered, salaries are increased. The system is further diluted with clueless retards AND the 1 billion in funds is blown on absolutely nothing, But great success in standardization can be proclaimed.

Is that too cynical?

In a word, NO!

 

[Sarg]

Wagon!!!! Shhhhhhhh! You CAN'T let their secrets out like that.

Sarg

 

[Wagon]

I worked in a company that did this. When people start talking best practice, I lose interest immediately.

The real secret is that "Best Practice" is code for:

A. I'm a mid level executive that wants to look smart in a meeting.
and
B. I'm mid level executive that knows if I say these two little words, allot of people below me will work hard, but I won't have to do a damn thing. Ha!

Best practice many times over is a local solution to a local problem. It's why there are regional hospitals besides the obvious...location and population. Because there are also cultural differences and a ton of other nuances about the area that are not common elsewhere. And being the humans we are, those will be solved in unique way.

The real solution nobody wants to do. The real solution is process mapping,, which requires that everyone's tasks are looked at in detail and how they fit into the next step in the process. Healthy......mildly sane Veterans are the product they produce. Sorry to say, but in big systems that is the way it should be viewed at some levels.

I know you have to differentiate between care and processing, but it seems they could easily at least sort out the processing part by doing a run down on their routines. From the stories I see on here, it is very symptomatic of a computer system that was built without even the slightest idea of how people work. Many many companies make this mistake. You nail down your processes first and then you build a system that specifically supports those processes. Not the other way around.

Case in point. In the military we had a job description....but it was not a process. We had processes for everything else that supported the role. Infantry.....kill bad guys. In VA and corporate land they say.."Hmm kill bad guys, we can build something to do that, here's this fancy weapon, now go kill bad guys" But the weapon is not going to kill bad guys for you. How do you get it there? How do you clean it? How do you fix it when broken? What are the limitations? How do you get the full potential out of the thing? And most certainly does it support your role and the routines you already have learned to do your job?

Now my head hurts......

And last. Well supported unstressed human beings make better decisions. Same in war, same in civvie land.